No-Fault Case Law

The court considered the appeal from an order of the Civil Court granting the defendant's motion for summary judgment dismissing the complaint. The main issue decided was whether the provider, TAM Medical Supply Corp., could recover assigned first-party no-fault benefits. The holding of the court was that the order granting the defendant's motion for summary judgment was affirmed, with $25 costs, for the same reasons as stated in a previous case, Metro Health Prods., Inc. v State Farm Mut. Auto. Ins. Co. The decision was reached by Pesce, P.J., Aliotta and Solomon, JJ. on September 15, 2016.

The facts of the case involved Restoration Chiropractic, P.C. seeking to recover assigned first-party no-fault benefits from New York Central Mutual Fire Insurance Company. The defendant had denied the plaintiff's claims on the basis that the assignor had failed to appear for independent medical examinations (IMEs) that were scheduled. The main issue decided by the court was whether the defendant's motion for summary judgment dismissing the complaint was justified based on the assignor's failure to appear for the scheduled IMEs. The court held that the proof submitted by the defendant was sufficient to establish that the IME scheduling letters and denial of claim forms had been properly mailed, and that the assignor had indeed failed to appear for the IMEs. As a result, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.

The court considered the denial of a motion for summary judgment in a case where a chiropractic office sought to recover assigned first-party no-fault benefits from an insurance company. The main issue decided was whether there was a triable issue of fact regarding the medical necessity of the services at issue. The holding of the court was that there was, in fact, a triable issue of fact regarding the medical necessity of the services, and as a result, the order denying the motion for summary judgment was affirmed. The case was decided on September 15, 2016, by the Appellate Term, Second Department.

The court considered the fact that the plaintiff, a provider seeking to recover assigned first-party no-fault benefits, had moved for summary judgment, and the defendant had cross-moved for summary judgment dismissing the complaint on the ground that the plaintiff's assignor had failed to appear for independent medical examinations (IMEs). The main issue decided was whether the defendant had established the timely and proper mailing of the IME scheduling letters and the denial of claim forms. The holding of the case was that the Civil Court denied the plaintiff's motion for summary judgment and granted the defendant's cross motion for summary judgment, and the Appellate Term affirmed this decision, with costs. The court found that the defendant had submitted affidavits that established the timely and proper mailing of the IME scheduling letters and denial of claim forms, and as a result, there was no basis to disturb the order.

The relevant facts considered by the court were that DAC Medical, P.C./Timothy Mosomillo, D.O. was seeking to recover first-party no-fault benefits from Allstate Insurance Company. The main issue decided was whether there was a triable issue of fact regarding the medical necessity of the services at issue. The court held that there was a triable issue of fact regarding the medical necessity of the services at issue and affirmed the order denying plaintiff's motion for summary judgment. The decision was made by the Supreme Court, Appellate Term, Second Department, with Pesce, P.J., Aliotta and Solomon, JJ., concurring.

The court considered a case where New Way Medical Supply Corp, as the assignee of Kathleem Long, was seeking to recover first-party no-fault benefits from State Farm Mutual Automobile Insurance Co. The main issue decided in this case was whether the defendant's motion for summary judgment dismissing the complaint should be granted. The holding of the court was that the order granting the defendant's motion for summary judgment to dismiss the complaint was affirmed. The court cited a previous case, Metro Health Prods., Inc. v State Farm Mut. Auto. Ins. Co. to support their decision, and the judges Pesce, Aliotta, and Solomon all concurred with the decision.

The court considered the defendant's motion for summary judgment dismissing the complaint from the plaintiff, a provider seeking to recover assigned first-party no-fault benefits. The main issue decided was whether the plaintiff's claims had been timely and properly denied on the ground that the plaintiff's assignor had failed to appear for duly scheduled independent medical examinations (IMEs). The court held that the address to which the IME scheduling letters were addressed improperly including an apartment number was not properly before the court as it was not raised in the plaintiff's opposition to the motion. The court also found no merit to the arguments raised by the plaintiff regarding the sufficiency of the defendant's proof of timely and proper mailing of the IME scheduling letters and denial of claim forms, and that the plaintiff's assignor had failed to appear for the duly scheduled IMEs. Therefore, the court affirmed the order granting the defendant's motion for summary judgment dismissing the complaint.

The court considered a case in which TAM Medical Supply Corp, as the assignee of Markens Belfort, was seeking to recover assigned first-party no-fault benefits from 21st Century Insurance Company. The main issue decided was whether the plaintiff's motion for summary judgment should be denied and the defendant's cross motion for summary judgment dismissing the complaint should be granted, due to the plaintiff failing to provide requested verification. The court held that the defendant's submissions were sufficient to give rise to a presumption that the initial and follow-up verification requests had been properly mailed, and demonstrated that it had not received the requested verification. As a result, the court found that the action was premature, and thus affirmed the order of the Civil Court denying the plaintiff's motion for summary judgment and granting the defendant's cross motion for summary judgment dismissing the complaint.

The main issues in this case were whether the defendant had properly mailed verification requests and denial of claim forms to the plaintiff, and whether the plaintiff's assignor had failed to comply with a condition precedent to coverage by not appearing for independent medical examinations. The court held that the defendant's affidavits were sufficient to give rise to a presumption that the verification request and denial of claim forms had been properly mailed. The court also held that the defendant had demonstrated that the plaintiff's assignor had failed to comply with a condition precedent to coverage. However, the court found that the defendant had not demonstrated that the claim underlying the plaintiff's second cause of action was timely denied, so the branch of the defendant's motion seeking summary judgment dismissing the second cause of action was denied. The court affirmed the order with modifications, denying the branch of defendant's motion seeking summary judgment dismissing plaintiff's second cause of action.

The court considered the fact that Compas Medical, P.C. was seeking to recover first-party no-fault benefits as an assignee of Richard James from Travelers Insurance Company. Travelers Insurance Company moved for summary judgment, arguing that the vehicle involved in the accident was not covered by their insurance policy at the time of the incident. The main issue decided by the court was whether the alleged injuries arose from an insured incident as per the insurance policy in question. The court held that Travelers Insurance Company had demonstrated prima facie that the injuries did not arise from an insured incident, and Compas Medical, P.C. failed to raise a triable issue of fact in opposition to this claim. Therefore, the court affirmed the order granting Travelers Insurance Company's motion for summary judgment dismissing the complaint.